Counseling and oral splint for conservative treatment of temporomandibular dysfunction: preliminary study / Aconselhamento e dispositivo interoclusal para tratamento conservador da disfunção temporomandibular: estudo preliminar

Introduction: Temporomandibular Disorders (TMD) involve the masticatory muscles, temporomandibular joint (TMJ) or both. The most common symptom is pain, which is usually located in the muscles of mastication, pre-auricular region, and / or ATM, especially during mandibular function. The main treatment for TMD is related to pain relief. Objective: The purpose of this case report was to evaluate the reduction of pain symptoms using Visual Analogue Scale (VAS) of patients with TMD treated with counseling and use of occlusal splint (OS). Material and method: 16 subjects had participated in this study, that was composed by 4 appointment with 7-day interval between each (CEP FOP / Unicamp - 137/2009). In the first, an examiner used the Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) to diagnose each patient and delivered a VAS to register the intensity of daily pain. In the second, counseling, molding of both dental arcs to fabricate the OS and the delivery of new VAS were performed. In the third, there was the installation and adjustment of the OS and the delivery of another scale, and in the last, possible adjustments on the OS were done. Data were analyzed by ANOVA two way and Tukey post-test at 5% significance level. Result: There was significant difference when comparing the intensity of pain of individuals after installation of splint with the baseline data and after counseling (p = 0.05). Conclusion: According to the result of this study, the treatment of TMD associating counseling occlusal splint is effective in reducing pain intensity.

Introdução: As desordens temporomandibulares (DTM) envolvem a musculatura mastigatória, as articulações temporomandibulares (ATM) ou ambas. O sintoma mais frequente é a dor, geralmente localizada nos músculos da mastigação, na região pré-auricular, e/ou na ATM, principalmente durante as funções mandibulares. O tratamento principal para pacientes com DTM consiste no alívio da dor. Objetivo: O objetivo deste estudo de relato de casos foi avaliar a redução da sintomatologia dolorosa, utilizando Escala Visual Analógica (EVA), de pacientes com DTM por meio do aconselhamento e utilização de dispositivos interoclusais (DI). Material e método: Um total de 16 indivíduos participaram deste estudo, composto de 4 consultas com intervalo de 7 dias entre cada uma delas (CEP FOP/Unicamp - 137/2009). Na primeira consulta, foi realizado o diagnóstico através do questionário para diagnóstico de DTM, o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) e entregue a EVA para registrar a intensidade de dor diária. Na segunda consulta, foi realizado o aconselhamento, moldagem para confecção dos DI e a entrega de nova EVA. Na terceira, houve a instalação e ajuste dos DI e a entrega de outra escala, e na última, realização de possíveis ajustes dos DI. Os dados foram analisados por meio do ANOVA a 2 critérios e utilizado o pós-teste de Tukey, com nível de significância de 5%. Resultado: Observou-se diferença significante quando se comparou a intensidade de dor dos indivíduos após instalação dos DI com as informações inicias da pesquisa e após o aconselhamento (p=0,05). Conclusão: A partir dos dados obtidos, pode-se concluir que o tratamento de DTM por meio do DI, seguido do aconselhamento, é eficaz na redução da intensidade da dor.

Técnicas de moldagem da máscara facial / Moulage of facial mask techniques

Introdução: Encontram-se descritas na literatura várias técnicas para moldagem da máscara facial com o intuito de obtenção de modelos para confecção de próteses bucomaxilofaciais. Objetivo: Este artigo tem como objetivo relatar duas técnicas de moldagem, a técnica convencional e a técnica convencional modificada, ressaltando suas vantagens e desvantagens. Técnica: A primeira técnica consiste na deposição do material de moldagem na região de interesse e, posteriormente, na adição da camada de reforço com gesso tipo II. A modificação da técnica convencional inicia-se com a realização de um alívio com algodão nos tecidos faciais a serem moldados, a aplicação de uma camada de gesso tipo II para a construção prévia da camada de reforço e, após sua cristalização, a aplicação do material de moldagem sobre a área a ser moldada, seguida de sua contenção por meio da máscara de gesso. Conclusão: A escolha da técnica de moldagem e dos materiais utilizados dependerá da habilidade do profissional. O importante é realizar uma moldagem que produza um modelo facial sem distorções para o sucesso da prótese.

Introduction: There are described in the literature several techniques for shaping the face mask in order to develop models for fabrication of maxillofacial prostheses. Objective: This article aims to describe two techniques used for facial moulage, the conventional technique and conventional technique with modification, highlighting their advantages and disadvantages. Case Report: In the first technique, the impression material is deposited over the region of interest and then a reinforcement layer of plaster type II is putting to cover the impression material. The modification of the conventional technique begins with a relief with cotton over the facial tissue, applying a layer of plaster type II in order to construct the reinforcement layer and, after its crystallization, the application of impression material over the area to be molded, followed by its plaster mask contention. Conclusion: The choice of impression technique and materials used will depend on the ability of the professional. The important thing is to make a moulage in order to get an accurate facial cast for the prosthesis' success.

Temporomandibular disorders in fibromyalgia: a critical view / Disfunção temporomandibular na fibromialgia: uma visão crítica

Temporomandibular disorders (TMD) and fibromyalgia (FM) are musculoskeletal syndromes that appear to be associated to each other. Various studies throughout the literature relate the signs and symptoms of TMD in patients with FM. The objective of this study was to analyze the literature regarding clinical association between FM and TMD. Even though these conditions present different etiologies, the pain modulating mechanisms are similar. Many studies in this field aim to elucidate questions which are still little understood. However, it has been observed that these syndromes are characterized by a reduction in pain threshold and in the attenuation capabilities of descending pain modulating systems. Moreover, there is a certain degree of comorbidities between these two pathologies, which share many clinical characteristics. Numerous patients with FM present various signs and symptoms of TMD, while only a small quantity of individuals with TMD is diagnosed with FM. Therefore, an adequate and precise evaluation of the stomatognathic system in patients with FM, which encompasses TMD diagnosis in therapeutic intervention, is paramount.

A disfunção temporomandibular (DTM) e a fibromialgia (FM) são síndromes musculo-esqueléticas que parecerem estar associadas. Vários estudos na literatura relatam sinais e sintomas da DTM em pacientes com FM. O objetivo deste trabalho foi analisar a literatura quanto à associação clínica entre fibromialgia e as disfunções temporomandibulares. Apesar de estes distúrbios possuírem etiologias diferentes, o mecanismo de modulação de dor é semelhante. Muitas pesquisas desenvolvidas nessa área buscam elucidar esta questão ainda pouco compreendida. Mas sugere-se que estas síndromes são caracterizadas por uma diminuição no limiar de dor e na capacidade de atenuação de sistemas descendente de modulação da dor. Além disso, há certo grau de comorbidade entre estas duas patologias, que compartilham muitas características clínicas. Muitos pacientes com FM apresentam vários sinais e sintomas de DTM, entretanto, uma pequena quantidade de indivíduos com DTM recebem um diagnóstico de FM. Portanto, é importante uma avaliação precisa e adequada do sistema estomatognático em pacientes com fibromialgia englobando o diagnóstico de disfunção temporomandibular na intervenção terapêutica

Impact on quality of life of removable partial denture wearers after 2 years of use

The use of clinical indicators of satisfaction (OHIP) can be applied to evaluate the impact of denture use on patient quality of life, since dental problems and disorders interfere in the normal life of individuals. Aim: This study aimed at evaluating the satisfaction level of patients rehabilitated with removable partial dentures (RPD) after 2 years of use. Methods: An observational study was carried out on 28 patients with a mean age of 45 years, treated with RPD at the Department of Dentistry of the Federal University of Rio Grande do Norte in 2005. Patients signed informed consent and answered the Oral Health Impact Profile (OHIP) questionnaire on three occasions: prior to rehabilitation and at 3 months and 2 years of denture use. Repeated-measures ANOVA was applied for data analysis. Results: A difference was found between data obtained at the moment of fitting and three months after denture use (p<0.001). However, no variation was observed when comparing data from 3 months and 2 years of use (p>0.05). The variables of gender and age did not interfere in the result (p>0.05). Conclusions: The degree of patient satisfaction after RPD installation was significant at the moment of fitting and 3 months after denture use, but no significant difference was found between 3 months and 2 years of denture use.

Selection of mandibular major connector based on a conventional impression technique

The selection of the mandibular major connector of a removable partial prosthesis depends on the distance between the floor of the mouth and free gingival margin, height of the lingual frenum,presence of mandibular tuberosity, mobility of anterior teeth, major connector used in a previous denture and patient’s opinion, slope and retentivity of alveolar bone. However, the dental technicianrather than the dentist often selects the major connector in the cast model. Aim: To determine whether there is a difference between selecting the mandibular major connector clinically or in thecast model as determined by a conventional impression technique using alginate and a universal metallic tray. Methods: The sample was composed of 64 patients under treatment at the Departmentof Dentistry of the Federal University of Rio Grande do Norte. The distance between the floor of the mouth and the free gingival margin of the remaining elements was measured with a millimeterperiodontal probe in the oral cavity and in the cast models. Results: The mean clinical distance between the free gingival margin and the floor of the mouth was 7.39 ± 2.13 mm, in contrast to themean distance found in the models (9.03 ± 1.36). The Mann-Whitney test showed a significant difference (p < 0.001) between the two measures. Conclusions: For the adequate selection ofthe mandibular major connector, the distance between the gingival margin and the floor of the mouth must be measured clinically when using the conventional impression technique.

Infraestructura de oro para prótesis metal-cerámicas obtenidas mediante técnica de electrodeposición / Infrastructure gold for metal-on-ceramic obtained by electrodeposition technique

La electrodeposición es un proceso químico por el cual se realiza una deposición galvánica de oro del 99% de pureza con el fin de obtener infraestructuras en prótesis metal-cerámicas. Las infraestructuras presentan, en promedio, un espesor de 0,2 mm y un desajuste marginal inferior la 20 µm, posibilitando la utilización de un mayor espesor de cerámica si la comparamos a técnicas convencionales. Esta técnica posibilita la disminución de la citotoxicidad, de las reacciones alérgicas y de la corrosión, determinando una mayor duración de las restauraciones. La coloración dorada del material permite al ceramista conseguir una estética más depurada, favoreciendo las tonalidades en la cerámica aplicada. Sin embargo, la necesidad de mano de obra calificada y de equipos modernos y de alto costo son factores que todavía hacen inviable la utilización de la electrodeposición de oro puro como práctica clínica habitual. El objetivo de este estudio es contribuir, a través de una revisión de la literatura, a la comparación en los siguientes factores: calidad del asentamiento marginal, durabilidad, biocompatibilidad, estética de las restauraciones cuyas estructuras hayan sido obtenidos por la técnica de electrodepoisición frente a restauraciones realizadas con técnicas metal-cerámicas convencionales y sistemas cerámicos

Electrodeposition is the galvanic deposition of 99% pure gold to obtain the framework for metal-ceramic prostheses. The framework is 0.2 mm thick, on average, with marginal maladjustment of less than 20 µm, enabling the use of greater ceramic thickness than that of conventional techniques. This new technique reduces cytotoxicity, allergic reactions and corrosion, resulting in longer restoration longevity. The golden coloration of the material allows the ceramist to develop a more evolved esthetic, favoring the tonality of the ceramic applied. However, the need for qualified labor and modern high-cost equipment are factors that hinder the use of electrodeposited pure gold in everyday clinical practice. The aim of this study is to perform a literature review to compare the quality of the marginal fit, longevity, biocompatibility, and esthetic of restorations whose copings were obtained by the electrodeposition technique using conventional metal-ceramics and ceramic systems